Infections in Patients with Chronic Lymphocytic Leukemia Treated with Chemoimmunotherapy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 720-720 ◽  
Author(s):  
Marina Motta ◽  
William Wierda ◽  
Susan O’Brien ◽  
Stefan Faderl ◽  
Alessandra Ferrajoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Chronic Lymphocytic Leukemia ◽  
Univariate Analysis ◽  
Pneumocystis Carinii ◽  
Lymphocytic Leukemia ◽  
Significant Activity ◽  
Serum Igg ◽  
Wbc Count ◽  
Low Serum

Abstract Chronic lymphocytic leukemia (CLL) is a clonal B cell malignancy characterized by defects in both cellular and humoral immunity. Each immune defect can be linked to common infectious complications affecting these patients. Predisposition to infections can be compounded by immunosuppression from cytotoxic chemotherapy. The purine analog fludarabine has been associated with a spectrum of infections caused by prolonged T lymphocyte depletion. The combination of fludarabine, cyclophosphamide, and rituximab (FCR) was developed based on complementary activity of the combination. FCR has significant activity in both chemotherapy-naïve (ChN) and previously treated (PrT) patients with CLL. We analyzed risk factors for infection and describe the infections experienced by both ChN and PrT patients during FCR treatment. We performed a retrospective review of medical records of 224 ChN and 177 PrT patients with CLL treated with the FCR regimen at MD Anderson Cancer Center from 7/99-8/02. Review was until relapse, death, or end of treatment. We focused on infectious events that occurred during and within 30 days of the last cycle of FCR treatment. Prophylaxis for herpes virus (valacyclovir) was recommended for all patients. Prophylaxis for P carinii (trimethoprim-sulfa) was recommended for all PrT patients and was done at the discretion of the treating physician for ChN patients. Infectious events were experienced by 96/224 (43.2%) ChN and 99/177 (56.2%) PrT patients. Causative agents were identified in 23% of events for ChN and 17% of events for the PrT patients (Table 1). There was a higher incidence of any event (p=0.012) and major infectious (MI) events (p<0.001) in PrT versus ChN patients. Major infections included pneumonia, sepsis and fever of unknown origin. Among ChN patients, univariate analysis identified low serum IgG (<700 mg/dL) (p=0.04), increased WBC count (p=0.049), and >2 chemotherapy courses (p=0.044) as risk factors for MI. Multivariate analysis identified low serum IgG (p=0.03) as the only predictor for MI. Among PrT patients, univariate analysis identified female gender (p=0.015) and baseline hemoglobin level (p=0.031) as risk factors for MI. Multivariate analysis identified increased WBC count (p=0.026) and high (>4.0 mg/dL) beta-2 microglobulin (ß2M) (p=0.027) as risk factors for MI in PrT patients. Among ChN and PrT patients none of the variables were found to be risk factor for minor infections (mI) in univariate analysis; multivariate analysis identified high ß2M (p=0.034) and splenomegaly (p=0.033) as significant predictors for occurrence of mI among PrT patients. For ChN patients, the nadir neutrophil count was not significantly associated with occurrence of mI or MI over the 6 courses of treatment. On the contrary, it was associated with occurrence of minor, major and any infection in the PrT patients. FCR is a higly effective and well-tolerated regimen. IgG <700 mg/dL was the main predictive variable for MI in ChN patients; baseline WBC count and ß2M >4.0 mg/L were the main predictive variables for MI in PrT patients. Table 1 Confirmed Infectious agent ChN Events/224 Pts PrT Events/177/Pts Gram+ bacteria 1 4 Gram- bacteria 4 1 Candida species 1 0 Aspergillus species 2 1 Pneumocystis carinii 2 0 VZV 3 6 HSV 6 4 CMV 3 1

A Prognostic Score for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma: Analysis of 2189 Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2783-2783
Author(s):  
Apostolia-Maria Tsimberidou ◽  
Peter McLaughlin ◽  
Susan O’Brien ◽  
Sijin Wen ◽  
William G. Wierda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Chronic Lymphocytic Leukemia ◽  
Prognostic Score ◽  
Lymphocytic Leukemia ◽  
Testing Time ◽  
Small Lymphocytic Lymphoma ◽  
Β2 Microglobulin ◽  
Risk Of Death ◽  
Genomic Aberrations

Abstract Introduction: The prognosis of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is heterogeneous. The purpose of this study was to assess factors predicting survival in patients with CLL/SLL. Methods: Characteristics at diagnosis were collected from 2189 patients with CLL/SLL who presented to The University of Texas M. D. Anderson Cancer Center between 1985 and 2005. Univariate and multivariate analyses for survival were performed. Pretreatment parameters that remained independently significant in the multivariate analysis were used to design a model to predict an individual patient’s risk of death: the CLL/SLL score. Results. The median age of patients was 58 years (range, 17–90 years). Overall, 1052 patients required treatment for CLL/SLL and 853 (81%) received fludarabine-based therapy. A multivariate analysis of 23 prognostic factors identified the following to have independent adverse significance for survival: 17p del and 6q del +/− other genomic aberrations (p<0.0001), age > 60 years (p<0.0001), albumin < 3.5 g/dL (p<0.0001), β2-microglobulin ≥ 2 mg/L (p<0.0001), creatinine ≥ 1.6 mg/dL (p<0.0001), hemoglobin <11 g/dL (p=0.001), presence of hepatomegaly (p=0.005), male sex (p=0.006), and absolute lymphocyte count ≥ 30 x 109/L (p=0.004). Other factors, such as IgVH mutation and CD38 or ZAP-70 expression, did not significantly correlate with survival, probably because these data were not available in enough patients and follow-up from the testing time was relatively short. The top five pretreatment parameters that remained independently significant in the multivariate analysis were used to design the CLL/SLL score in 1564 patients who had available data for all five parameters. Since the relative risks associated with each of the top five independently significant risk factors were comparable, the relative risk of death could be determined by summing the number of risk factors present at diagnosis. At 5 years, 96%, 79%, 69%, 30%, and 16% of patients with 0, 1, 2, 3, or 4 (including 1 patient with a score of 5) risk factors, respectively, are expected to be alive [insert Figure here]. Conclusions: A prognostic score to predict survival in patients with CLL/SLL is proposed. The score is based on the five most statistically significant independent factors, i.e., 17p or 6q del +/− other genomic aberrations; age; and levels of β2-microglobulin, albumin, and creatinine. This score may be used to identify specific risk groups, to improve treatment choices and to compare different therapeutic approaches in patients with CLL/SLL. Figure Figure

scholarly journals Risk Factors Associated with Richter's Transformation in Patients with Chronic Lymphocytic Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1697-1697 ◽  
Author(s):  
Yasmin Ben-Dali ◽  
Mariam Hussein Hleuhel ◽  
Michael Asger Andersen ◽  
Christian Brieghel ◽  
Erik Clasen-Linde ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Lymphocytic Leukemia ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
Research Funding ◽  
Univariate Analysis ◽  
Lymphocytic Leukemia ◽  
Increased Risk ◽  
Binet Stage

Abstract Background Richter's transformation (RT) refers to the development of an aggressive lymphoma in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL). Roughly, 2-10 % of patients with CLL develop RT most often as diffuse large B-cell lymphoma (DLBCL) or Hodgkin lymphoma (HL). Aim This study aimed to assess the incidence rate and risk factors for RT for patients with CLL in a nationwide cohort. Furthermore, we want to assess prognostic risk factors for patients with RT. Methods All patients diagnosed with CLL in Denmark between 2008 and 2016 were included in this study. Clinical data was retrieved from the Danish National CLL Registry (DCLLR), whereas all histologically verified DLBCL, HL and/or transformation diagnoses for patients with CLL were retrieved from the Danish National Pathology Registry. Patients were followed from date of CLL diagnosis until date of RT, death or end of follow-up, whichever came first. The time to RT was estimated as cumulative incidence considering death as a competing risk. Stepwise Cox analysis with backward elimination was applied to identify independent risk factors for RT in patients with CLL. Results A total of 3771 CLL patients were identified, and followed for 14165 person-years. With a median follow-up of 4.3 (IQR (2.4;6.6)) years, 120 (3%) CLL patients had a transformation diagnosis, of which 4 patients were excluded due to misdiagnosis. DLBCL accounted for 78/116 (67%) cases, HL for 15/116 (13%) cases and one patient presented with both DLBCL and HL. In the remaining 22/116 (19%) cases the subtype of the transformation was either unspecified or unclassified RT. The median time to RT was 3.4 (IQR (1.8;5.7)) years from CLL diagnosis and the median overall survival (OS) after development of RT was 4.9 (IQR (0.7;8.4)) years. The cumulative incidence of RT, calculated by Aalen-Johansen estimator, at 5 and 8 years post-CLL diagnosis were 3.3% and 7.9% respectively (Figure 1). The annual crude incidence rate of RT was approximately 0.7% per year for all CLL patients. In all, 918 (24%) patients received CLL-related treatment, of whom 59 (6.4%) patients developed RT, resulting in a cumulative incidence of RT of 7% after 5 years and 11% after 8 years. At the time of CLL diagnosis, patients treated for CLL prior to RT diagnosis had a worse median OS (1.49 years) compared to RT patients who were untreated for CLL (6.16 years). In the univariate analysis, RT was significantly associated with male gender, advanced Binet stage (B or C), unmutated IGHV status (CLL-U), elevated beta-2-microglobulin (>3.5 mg/L) and elevated lactate dehydrogenase (>205 U/L). Of cytogenic aberration, deletion 13q (del(13q)) had a protective effect on the risk of RT, whereas deletion 11q (del(11q)) and deletion 17p (del(17p)) increased the risk. In the multivariable model, advanced Binet stage (HR 2.86 (1.82;4.51), p<0.001), del(17p) ((HR 3.74 (2.12;6.61), p<0.001) and CLL-U ((HR 2.30 (1.46;3.63), p<0.001) showed an independent correlation with development of RT. ZAP70 and CD38 were excluded from statistical analyses due to incomplete data and high inter-laboratory variation. Among RT patients, CLL-U, trisomy 12 and del(17p) at CLL diagnosis as well as ECOG Performance Status (PS) (i.e. PS≥1) at time of RT diagnosis correlated with poor OS in univariate analysis. Both del(17p) and PS≥1 were independently associated with an increased risk of death in a multivariable analysis (HR 2.9, (1.1;7.7), p=0.04 and HR 3.0, (1.0;3.1), p=0.05, respectively). Conclusions To the best of our knowledge, we here report the largest study on RT assessing nationwide data of consecutive patients diagnosed with CLL. The incidence of RT in this unselected population was 3.3% after 5 years while the median OS for patients from time of RT was 4.9 years. Advanced Binet stage, del(17p) and CLL-U were significantly and independently associated with an increased risk of RT. Del(17p) at CLL diagnosis and PS≥1 at RT diagnosis were significant predictors for death for patients with RT. For patients diagnosed with RT prior to any CLL treatment, a less severe disease course with a median OS of 6.16 years was demonstrated. Contrary, the median OS for patients receiving prior CLL treatment was 1.49 years. Thus, assessment of different treatment options for patients developing RT based on whether they have received prior CLL treatment or not is warranted. Figure 1. Figure 1. Disclosures Ben-Dali: Rigshospitalet: Research Funding. Hleuhel:Rigshospitalet: Research Funding. Brieghel:Arvid Nilson's Fund: Research Funding; Rigshospitalet, Denmark: Research Funding. Niemann:Danish Cancer Society: Research Funding; Novo Nordisk Foundation: Research Funding; Janssen: Consultancy, Research Funding; Abbvie: Consultancy, Research Funding; Novartis: Consultancy; Roche: Consultancy; Gilead: Consultancy; AstraZeneca: Consultancy; CSL Behring: Consultancy.

scholarly journals Upper Respiratory Tract Colonization by Gram-Negative Rods in Patients with Chronic Lymphocytic Leukemia: Analysis of Risk Factors

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Izabela Korona-Glowniak ◽  
Ewelina Grywalska ◽  
Beata Chudzik ◽  
Agnieszka Bojarska-Junak ◽  
Anna Malm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Chronic Lymphocytic Leukemia ◽  
Respiratory Tract ◽  
Lymphocytic Leukemia ◽  
Upper Respiratory Tract ◽  
Stage Number ◽  
Gram Negative ◽  
Upper Respiratory ◽  
Respiratory Tract Colonization

The aim of the study was to assess the frequency and predisposing factors of colonization of upper respiratory tract by Gram-negative rods (GNRs) in chronic lymphocytic leukemia (CLL) patients. Antimicrobial susceptibility of the isolated strains was determined. A significantly higher frequency of GNR colonization in CLL patients was observed (36.7%) in comparison to healthy volunteers (8.3%). GNR isolates mainly belonged to the Enterobacteriaceae family. Three isolates of GNR demonstrating presence of AmpCβ-lactamases and one ESBL-producing strain were obtained from CLL patients. GNR colonization rate was higher among CLL patients with lower level of IgG in serum (P=0.017), with higher number of neutrophils (P=0.039) or higher number of lymphocytes in serum (P=0.053). The longer the time elapsed since diagnosis, the higher the frequency of GNR colonization observed. Multivariate analysis showed importance of the Rai stage, number, and type of infections as independent predictors of GNR colonization in CLL patients.

Mutations of NOTCH1 Are An Independent Predictor of Survival in Chronic Lymphocytic Leukemia

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 283-283
Author(s):  
Davide Rossi ◽  
Silvia Rasi ◽  
Giulia Fabbri ◽  
Valeria Spina ◽  
Marco Fangazio ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
High Risk ◽  
Chronic Lymphocytic Leukemia ◽  
Univariate Analysis ◽  
Lymphocytic Leukemia ◽  
Prognostic Impact ◽  
Prognostic Role ◽  
Trisomy 12 ◽  
Notch1 Mutations

Abstract Abstract 283 The clinical course of chronic lymphocytic leukemia (CLL) ranges from very indolent, with a nearly normal life expectancy, to rapidly progressive leading to death and occasionally undergoing transformation to Richter syndrome (RS). TP53 disruption identifies a fraction of high risk CLL destined to experience a very short survival. High risk CLL, however, cannot be fully recapitulated by TP53 disruption and other lesions of cancer genes may be implicated in this aggressive phenotype. Analysis of the CLL coding genome has recently disclosed that the NOTCH1 proto-oncogene is recurrently mutated at CLL presentation. Here we assessed the prognostic role of NOTCH1 mutations in CLL. Two series of previously untreated CLL were utilized as training (n=309, median follow-up 6 years) and validation (n=230, median follow-up 7 years) cohorts. NOTCH1 mutations were analyzed by DNA Sanger sequencing in blind with respect to clinical data. In the training series, NOTCH1 mutations occurred in 34/309 (11.0%) patients, being mostly represented (26/34, 76.5%) by a recurrent two bp frameshift deletion (c.7544_7545delCT). The remaining NOTCH1 mutations (8/34, 23.5%) were frameshift deletions other than c.7544_7545delCT (n=7) and frameshift insertions (n=1). All mutations were predicted to disrupt the NOTCH1 PEST domain. CLL with NOTCH1 mutations preferentially carried unmutated IGHV genes (76.5%, p<.001). Other characteristics at presentation associated with NOTCH1 mutations were advanced Rai stage (26.5%, p=.006) and trisomy 12 (44.1%, p<.001). By univariate analysis, NOTCH1 mutations associated with an increase in the hazard of death (HR: 3.77; 95% CI: 2.14–6.66) and a significant overall survival OS shortening (p<.001) (Fig. 1A). Multivariate analysis selected NOTCH1 mutations as an independent risk factor of OS (HR: 4.22; 95% CI: 2.15–8.28; p<.001), after adjusting for age (p<.001), Rai stage (p=.005), IGHV mutation status (p=.465), 11q22-q23 deletion (p=.128), trisomy 12 (p=.183) and TP53 disruption (p<.001). The poor prognosis conferred by NOTCH1 mutations was attributable, at least in part, to a shorter time to progression requiring treatment (p<.001), and a higher cumulative probability of RS development (p=.026). Although NOTCH1 mutated patients were devoid of TP53 disruption in 31/34 (91.2%) cases, the OS predicted by NOTCH1 mutations was similar to that of TP53 mutated/deleted CLL (Fig. 1C). Analysis of the validation series confirmed: i) the prevalence of NOTCH1 mutations at CLL presentation (26/230, 11.3%); ii) the spectrum of NOTCH1 mutations at CLL presentation (c.7544_7545delCT: 21/26, 80.7%; other mutations: 5/26, 19.3%) iii) the adverse prognostic impact of NOTCH1 mutations in CLL both by univariate analysis (Fig. 1B) and by multivariate analysis (HR: 2.08; 95% CI: 1.10–3.93; p=.023); iv) the preferential mutually exclusive distribution of NOTCH1 mutations and TP53 disruption (25/26, 96.2%); v) that OS of NOTCH1 mutated CLL is similarly poor as that of TP53 disrupted CLL (Fig. 1D). The current study on 539 CLL documents that NOTCH1 mutations: i) represent one of the most frequent cancer gene mutations known to be involved at CLL presentation; ii) identify a subgroup of patients showing poor OS similar to that of TP53 disrupted cases; iii) exert a prognostic role independent of widely accepted clinical and genetic risk factors; iv) predict OS in series from different institutions, as documented by the training-validation approach chosen for the design of this study. Disclosures: No relevant conflicts of interest to declare.

Long-Term Capd Survival and Analysis of Mortality Risk Factors: 12-Year Experience of a Single Mexican Center

2001 ◽  
Vol 21 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Alfonso M. Cueto–Manzano ◽  
Eduardo Quintana–Piña ◽  
Ricardo Correa–Rotter
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
Old Age ◽  
Mortality Risk ◽  
Patient Survival ◽  
Univariate Analysis ◽  
Technique Survival ◽  
Technique Failure ◽  
Low Serum

Objective To evaluate patient and technique survival, and to analyze mortality risk factors in a large Mexican single-center continuous ambulatory peritoneal dialysis (CAPD) program. Design Cohort study. Setting Tertiary care, teaching hospital located in Mexico City. Patients All patients from our CAPD program (1985 – 1997) were retrospectively studied. Interventions Clinical and biochemical variables at the start of dialysis were recorded and considered in the analysis of risk factors. Main Outcome Measures End points were patient (alive, dead, or lost to follow-up) and technique status at the end of the study (December 1997). Results 627 patients, 37% with diabetes mellitus (DM), were included. Median patient survival (± SE) was 5.1 ± 0.6 years. In the univariate analysis, the following variables were associated ( p < 0.05) with mortality: DM, old age, hypoalbuminemia, low serum creatinine, low serum phosphate, and lymphopenia. In the multivariate analysis, the only significant mortality risk factors were DM (RR 2.56, p < 0.0001), old age (RR 1.01, p = 0.01), hypoalbuminemia (RR 0.77, p = 0.04), and lymphopenia (RR 0.98, p = 0.05). Median technique survival was 4.0 ± 0.2 years. Peritonitis, hypoalbuminemia, lymphopenia, old age, and DM were all significantly associated ( p < 0.05) with technique failure in the univariate analysis, while in the multivariate analysis, only DM (RR 1.78, p = 0.001), peritonitis (RR 1.13, p = 0.004), lymphopenia (0.98, p = 0.04), and hypoalbuminemia (RR 0.80, p = 0.06) were technique failure predictors. Conclusions Patient survival in our setting is similar to that reported in other series. Diabetes mellitus, lymphopenia, and hypoalbuminemia were the strongest predictive factors for mortality and technique failure on CAPD. Our 12-year CAPD program is one of the largest single-centers reported in CAPD literature.

Alemtuzumab in Previously Treated Chronic Lymphocytic Leukemia Patients Who Also Had Received Fludarabine

2002 ◽  
Vol 20 (18) ◽  
pp. 3891-3897 ◽  
Author(s):  
K. R. Rai ◽  
C. E. Freter ◽  
R. J. Mercier ◽  
M. R. Cooper ◽  
B. S. Mitchell ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Median Time ◽  
Opportunistic Infections ◽  
Antimicrobial Prophylaxis ◽  
Pneumocystis Carinii ◽  
The United States ◽  
Lymphocytic Leukemia ◽  
Significant Activity ◽  
Major Response ◽  
Duration Of Response

PURPOSE: This phase II pilot study determined the efficacy and safety of alemtuzumab (Campath-1H; Burroughs Wellcome, United Kingdom) in patients with chronic lymphocytic leukemia (CLL), all of whom had previously received fludarabine and other chemotherapy regimens. PATIENTS AND METHODS: Twenty-four patients were treated with intravenous alemtuzumab at six centers in the United States. The target dose of 30 mg over 2 hours, three times weekly, was administered for up to 16 weeks. Responses were evaluated by an independent panel of experts using 1996 National Cancer Institute–sponsored Working Group criteria. Safety assessments included analysis of lymphocyte subpopulations. Antimicrobial prophylaxis was not mandatory. RESULTS: Eight patients (33%) achieved a major response (all partial remissions), with a median time to response of 3.9 months (range, 1.6 to 5.3 months). The median duration of response was 15.4 months (range, 4.6 to ≥ 38.0 months), the median time to disease progression was 19.6 months (range, 7.7 to ≥ 42.0 months), and the median survival time was 35.8 months (range, 8.8 to ≥ 47.1 months). Acute infusion-related events, mainly grades 1 and 2, were most common and most severe in the first week. Ten patients (eight nonresponders and two responders) experienced major infections on-study. Pneumocystis carinii pneumonia was reported in two patients on-study; neither had received prophylaxis. Median CD4+ and CD8+ counts decreased and then began to increase by the end of the study, with further recovery by 1-month follow-up. One of 53 samples obtained from 10 patients had a low titer of alemtuzumab antibodies. CONCLUSION: Alemtuzumab has significant activity in poor-prognosis, fludarabine-treated CLL patients. However, because of a relatively high incidence of opportunistic infections accompanying profound lymphopenia, future protocols should include mandatory prophylaxis.

scholarly journals Risk Factor Analysis for Infection after Medial Open Wedge High Tibial Osteotomy

2021 ◽  
Vol 10 (8) ◽  
pp. 1727
Author(s):  
Ta-Wei Liu ◽  
Chih-Hao Chiu ◽  
Alvin Chao-Yu Chen ◽  
Shih-Sheng Chang ◽  
Yi-Sheng Chan
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
High Tibial Osteotomy ◽  
Univariate Analysis ◽  
Arthroscopic Surgery ◽  
Underlying Disease ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

Background: Medial open wedge high tibial osteotomy (MOWHTO) is a well-established treatment for osteoarthritis of the medial tibiofemoral compartment. Surgical site infection (SSI) after MOWHTO is a devastating complication that may require further surgery. In this study, we aimed to identify the risk factors for infection after MOWHTO over 1 to 4 years of follow-up. Methods: Fifty-nine patients who underwent MOWHTO combined with knee arthroscopic surgery were included in this prospective study. Artificial bone grafts were used in all cases. Possible risk factors, including sex, age, body mass index (BMI), underlying disease, hospitalization length, correction angle, and surgery time, were recorded. Both univariate and multivariate analysis were used. Results: A total of 59 patients who underwent 61 operations were included. Eleven patients (18.0%) were reported to have SSI. Univariate analysis showed that smoking and diabetes mellitus were positively associated with SSI. Multivariate analysis showed that smoking and age were positively associated with SSI. Three patients (4.9%) were reported to suffer from deep SSI, requiring surgical debridement, all of whom were male smokers. Conclusion: Smoking, diabetes mellitus, and old age were identified to be possible risk factors of SSI after MOWHTO. These findings are common risk factors of SSI after orthopedic surgery according to the literature. Patient selection should be performed cautiously, and postoperative prognosis for MOWHTO should be carefully explained to patients who smoke.

Prognostic Factors for Developing Thrombosis in Polycytemia Vera: A Retrospective Analysis of 331 Patients with Long-Term Follow-up Highlights the Importance of White Blood Cells Levels

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 48-49
Author(s):  
Samantha Ferrari ◽  
Chiara Pagani ◽  
Mariella D'Adda ◽  
Nicola Bianchetti ◽  
Annamaria Pelizzari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
High Risk ◽  
Board Of Directors ◽  
Advisory Board ◽  
Advisory Committees ◽  
Risk Status ◽  
History Of ◽  
Wbc Count

Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm characterized by erythrocytosis, constitutively active mutations in JAK2 and an increased susceptibility to thrombotic events (TEs). There is still controversy about the role of increased hematocrit and of other variables including elevated white blood cell count as risk factors for the occurrence of TEs. A better definition of the relative prognostic importance of hematologic parameters would help us to better tailor the therapeutic approach to PV patients (pts), which is currently mainly based on the use of acetilsalycilic acid (ASA), venesection and hydroxyurea . The aim of our study was to analyze if any clinical or laboratory variables were significantly associated to the occurrence of TEs both at PV diagnosis and during the course of the disease in a large series of PV pts uniformly followed at a single Center over a period of 29.5 years from January 1986 to June 2019. Clinical and laboratory data were obtained from the time of diagnosis until death, progression to acute leukemia or last follow-up. Hematocrit (Hct), hemoglobin (Hb), white blood cell (WBC) and platelet (PLT) levels were recorded for each patient at least every 6 months. Among a total of 331 pts, the median age was 65 years (range 30-92 years), and 56% were male. "High risk" features (age ≥ 60 years and/or history of prior thrombosis) were present in 221 pts (66.7%). The incidence of cardiovascular risk factors was: hypertension 64%, diabetes 15%, hyperlipidemia 28%, history of active or remote smoking 41%. Patients on ASA were 279 (84%), 19 (6%) were on oral anticoagulation, while 27 (8%) were on ASA+oral anticoagulant. At PV diagnosis 54 pts (16%) presented with thrombosis, arterial in 32 (59%) and venous in 22 (41%). A previous TE was recorded in 57 pts (17%): in 43 (75%) arterial, in 12 (22%) venous and in 2 (3%) mixed (arterial+venous). Previous thrombosis was the only variable significantly associated with the presence of a TE at PV diagnosis (P=0.02). After PV diagnosis, with a median follow-up of 81 months (range 1-374 months), 63 pts (19%) experienced a TE and 11 of them a further episode, for a total of 74 TEs. The incidence rate (pts/year) of TEs was 2.7%. Forty-two events were arterial (57%), 31 were venous (42%) and 1 (1%) was mixed. It was the first TE for 37 pts. Cerebrovascular accidents and deep-venous thrombosis were the most frequent arterial and venous TEs both at PV diagnosis and throughout the disease course, with a relative incidence of 50% and 32% respectively. The table compares the characteristics of patients who did or did not develop a TE after PV diagnosis. At univariate analysis, PV high risk status, a previous TE and hyperlipidemia at PV diagnosis were significantly associated with a subsequent TE. Among hematologic variables an elevated WBC count at the time of thrombosis, but not Hct or PLT levels, was highly significantly associated with the development of a TE. At multivariate analysis, WBC count ≥10.4 x 10^9/L and hyperlipidemia maintained their independent prognostic value, while high risk status and a previous TE lost their prognostic significance. Both at univariate and multivariate analysis, hyperlipidemia at diagnosis (P=0.009 and P=0.002) and high WBC count at thrombosis (P=0.001 and P=&lt;0.0001) predicted for arterial thromboses, while only a history of prior thrombosis (P=0.03) predicted for venous ones. In conclusion, our analysis confirms that elevated WBC count at the moment of the event more than increased hematocrit is associated to the development of thrombosis in PV pts. We also found that hyperlipidemia was an independent risk factor for arterial thrombosis, calling for an accurate management of increased lipid levels. Whether a reduction of the WBC count during the course of PV may reduce the frequency of TE remains to be demonstrated by prospective studies. Table Disclosures D'Adda: Novartis: Other: Advisory board; Incyte: Other: Advisory board; Pfizer: Other: Advisory board. Rossi:Daiichi Sankyo: Consultancy, Honoraria; Sanofi: Honoraria; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: Advisory board; Alexion: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria; Celgene: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Jazz: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees.

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